Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 47 , Issue 23
Showing 1-21 articles out of 21 articles from the selected issue
ORIGINAL ARTICLES
  • Hideto Ishii, Toyohiro Tsukada, Masayuki Yoshida
    2008 Volume 47 Issue 23 Pages 2013-2018
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Background Hypertension in diabetic patients has been shown to accelerate the progression of atherosclerosis and angiotensin II type-I (AT1) receptor blocker (ARB) has been shown to have anti-atherosclerosis action independent of its action on blood pressure.
    Methods and Results Type 2 diabetic patients with hypertension received either ARB (candesartan), or a calcium channel blocker (CCB; amlodipine or nifedipine) for 12 weeks. Though clinical parameters such as blood glucose, HbA1c, and systolic and diastolic pressure were not significantly changed between the two groups, brachial-ankle pulse wave velocity (baPWV) was significantly reduced in the candesartan group when compared to CCB groups. Moreover, candesartan treatment exhibited a tendency of reduction in inflammation markers such as high sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6).
    Conclusion We conclude that candesartan may improve vascular inflammation independent of its effect on hypertension in diabetes, thus suggesting its efficacy in diabetic patients.
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  • Ko-ichi Tazawa, Masayuki Matsuda, Takuhiro Yoshida, Yasuhiro Shimojima ...
    2008 Volume 47 Issue 23 Pages 2019-2024
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Objective To investigate the clinical usefulness of measuring diameters of spinal nerve roots on magnetic resonance imaging (MRI) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with regard to the diagnosis and estimation of neurofunctional impairment.
    Patients and Methods Fourteen patients with CIDP (mean age, 38.9±19.2 years) and 10 controls were enrolled in this study. Diameters of cervical and lumbosacral spinal nerve roots were determined on the short tau inversion recovery image of MRI. Correlations between these diameters and clinical indices, including the conduction velocity of median and tibial nerves, were examined.
    Results Mean diameters of cervical and lumbosacral spinal nerve roots in CIDP patients were 6.0 to 6.8 mm and 7.3 to 10.4 mm, respectively. CIDP patients showed higher values of the diameter in C5 (p<0.05), C6 (p<0.05), C7 (p<0.005) and C8 (p<0.01) than controls. C7 and C8 showed significantly negative correlations between diameters of spinal nerve roots and the F-wave conduction velocity (FWCV) (p<0.05). In the lumbosacral region, L3, L4 and S1 showed significantly negative correlations between diameters of spinal nerve roots and FWCV (p<0.005, p<0.0005 and p<0.005, respectively). The latency-time difference between F- and M-waves increased with diameters of spinal nerve roots, and there were significantly positive correlations between them in L3 (p<0.05) and L4 (p<0.005).
    Conclusion Hypertrophy of spinal nerve roots shown on MRI may be useful as a clue to the diagnosis of CIDP and also as a clinical marker suggesting impairment of peripheral nerve conduction, particularly FWCV.
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CASE REPORTS
  • Oh Hyoung-Chul, Kim Jae Gyu, Kim Jeong Wook, Lee Kwang Sun, Kim Mi Kyu ...
    2008 Volume 47 Issue 23 Pages 2025-2028
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    A 59-year-old man presented with recent onset jaundice. Initial laboratory and radiologic findings suggested autoimmune pancreatitis (AIP) with consequent obstructive jaundice. All serologic markers for AIP were, however, normal. To confirm the histologic finding of AIP and exclude the possibility of cancer at the thickened segment of common bile duct, cholangioscopic examination was performed and bile duct cancer was observed. The resected specimen showed typical features of AIP throughout the entire pancreas and early carcinomatous change on a background of abundant IgG4-positive cells in the common bile duct. Although chronic biliary inflammation and cholestasis are among bile duct cancer risk factors, the cause-and-effect relationship between sclerosing cholangitis and bile duct cancer needs to be determined by further study, as between AIP and pancreatic cancer. Importantly, histologic exclusion of malignancy is another essential step in the diagnosis of AIP and sclerosing cholangitis as malignancy may coexist in bile duct as well as in the pancreas.
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  • Takaya Shimura, Hiromi Kataoka, Makoto Sasaki, Eiji Kubota, Shigehiro ...
    2008 Volume 47 Issue 23 Pages 2029-2031
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Inflammatory fibroid polyp (IFP) is a rare benign tumor originating from the submucosa of the gastrointestinal tract. Most are found in the stomach, with only one previous case reported in the rectum. IFPs are typically larger than 1 cm in diameter and present symptoms. Colonoscopic examination of an asymptomatic 66-year-old man revealed a small submucosal tumor, 3 mm in diameter, in the rectum. The lesion was completely resected by endoscopic submucosal dissection (ESD) and was histopathologically diagnosed as IFP. We report herein a very rare rectal IFP that could be treated and diagnosed with ESD.
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  • Kek Peng Chin, Yeo Chin Pin
    2008 Volume 47 Issue 23 Pages 2033-2037
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Immunoassays are one of the main methods of measuring thyroid hormones. They are prone to interference. Interference of the immunoassays has been increasingly recognized as a problem because it may lead to misinterpretation of results resulting in unnecessary investigation and wrong course of treatment. We describe a patient who had interference in her thyroid function measurements (free T4, free T3 and TSH) during the course of treatment for Graves' disease.
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  • Mehmet Horoz, Ebru Gok, Gultekin Genctoy, Turkay Ozcan, Refik Olmaz, M ...
    2008 Volume 47 Issue 23 Pages 2039-2042
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Patients, especially those with chronic disease and disorders are increasingly relying on complementary and alternative medical therapies (CAMT). Because the use of CAMT is escalating worldwide, it is essential to be aware of the clinical and adverse effects, doses and potential drug-herb interactions. Crataegus orientalis or hawthorn is a small tree with red fruits. A number of studies appear to demonstrate that Crataegus spp. have a clinically detectable positive cardiac inotropic action. The ingredients, characteristics of metabolism and elimination, and adverse effects of hawthorn remain largely unknown. We report a case of multisystem hypersensitivity reaction and progressive acute renal failure associated with the consumption of Crataegus orientalis.
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  • Masafumi Seki, Naofumi Suyama, Kohji Hashiguchi, Atsuko Hara, Kosuke K ...
    2008 Volume 47 Issue 23 Pages 2043-2047
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    A 74-year-old man with poorly controlled diabetes mellitus was admitted to our hospital because of severe respiratory disturbance, fever, and sputum. We found massive consolidation of the right lung and nodular shadows on the left lung on chest X-ray, and detected influenza virus and Streptococcus pneumoniae antigen from a nasopharyngeal swab and urine sample, respectively. Co-infection with influenza virus and bacteria was suspected, and oseltamivir and biapenem were prescribed. Laboratory data improved after the addition of sivelestat sodium hydrate, an inhibitor of neutrophil-derived elastase; however, chest X-ray findings became worse on Day 8, and we administered 1 g methylprednisolone intravenously for two days. On Day 12, we detected Mycobacterium tuberculosis in the sputum, even though we did not previously detect any acid-fast bacilli, and started anti-tuberculosis drugs, such as isoniazid, rifampicin, ethambutol hydrochloride, and pyrazinamide; however, the patient died 12 days later. Severe influenza-related bacterial pneumonia with Streptococcus pneumoniae and subsequently secondary tuberculosis infection were finally suspected in this case. This was a very rare case in which additional tuberculosis infection was found in a patient with fulminant pneumonia due to co-infection of influenza virus and bacteria. It is necessary to observe patients with influenza carefully, especially when steroids are used, even if antibiotics are also administered.
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  • Hirokazu Tokuyasu, Tomoya Harada, Hirokazu Touge, Yuji Kawasaki, Ryo M ...
    2008 Volume 47 Issue 23 Pages 2049-2052
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    A 51-year-old woman suffered from xerophthalmia and xerostomia for 3 years without being medically examined. In July 2006, she was referred to our hospital for the evaluation of chest roentgenogram showing slight pleural effusion in the right lung. A chest CT scan revealed multiple nodules, enlarged mediastinal and hilar lymph nodes, and bilateral slight pleural effusions. A diagnosis of Sjögren's syndrome was made on the basis of the results of sialography, lip biopsy, Schirmer's test, and elevated titer of antibody to SS-A antigen. Histological examination of the specimen from the nodular lesion by video-assisted thoracoscopic biopsy revealed noncaseating epithelioid cell granuloma containing giant cells, which confirmed the diagnosis of sarcoidosis. Although the coexistence of Sjögren's syndrome and sarcoidosis has been reported occasionally, cases with histological evidence of sarcoidosis have been rare. Pulmonary sarcoidosis should be considered in the differential diagnosis of pulmonary multiple nodules in patients with Sjögren's syndrome.
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  • Tatsuo Kimura, Koichi Koyama, Shinzoh Kudoh, Joji Kawabe, Naruo Yoshim ...
    2008 Volume 47 Issue 23 Pages 2053-2056
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    We report a 56-year-old man who underwent monitoring of the response to chemotherapy of malignant pleural mesothelioma (MPM). 8F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and computed tomography (CT) were performed prior to chemotherapy and after the first and second courses of chemotherapy. The tumor lesion exhibited shrinkage on CT and a decrease in the standardized uptake value (SUV) max after the first course of chemotherapy, but exhibited size enlargement and an increase in SUV max after the second course of chemotherapy. These findings suggest that results of quantification of metabolic response by FDG-PET are related to the objectiveresponse as determined by CT in patients with MPM.
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  • Hiromichi Matsushita, Naoya Nakamura, Satomi Asai, Miharu Yabe, Naoki ...
    2008 Volume 47 Issue 23 Pages 2057-2062
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    We report an 81-year-old man who had leukemic presentation of ALK-positive anaplastic large cell lymphoma (ALCL) as an initial manifestation. He had been well after chemotherapy and irradiation for the advanced lung adenocarcinoma, but suddenly suffered from severe lactic acidosis and hypotension. The peripheral blood smear and bone marrow aspiration revealed the infiltration of atypical large cells with horseshoe-shaped or lobulated nuclei. The detection of CD30 expression and the t (2;5) (p23;q35) translocation in these cells was confirmatory of a diagnosis of common variant ALK-positive ALCL in a leukemic phase. He deteriorated rapidly and died before administration of the chemotherapy. An adequate, prompt diagnosis is necessary for this rare disease status in oncologic emergency to improve the disease management.
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  • Osamu Imataki, Hiroaki Ohnishi, Akira Kitanaka, Yoshitsugu Kubota, Tos ...
    2008 Volume 47 Issue 23 Pages 2063-2065
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Only a dozen cases of pancytopenia caused by copper deficiency have been reported. We report the case of an 81-year-old man who underwent total gastrectomy for gastric cancer. He received total parenteral nutrition without trace element supplementation for 6 months. Serum levels of copper and ceruloplasmin were low, but serum zinc was normal. The administration of copper into TPN led to rapid improvement in anemia and neutropenia. We review 11 previous cases of copper-deficient cytopenia, categorized into two groups according to etiology, and define the characteristic symptom of copper malabsorption caused by excess Zn as peripheral neuropathy.
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  • Toshiki Mizuno, Manabu Muranishi, Torusunjian Torugun, Hiromi Tango, Y ...
    2008 Volume 47 Issue 23 Pages 2067-2072
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Most previously reported mutations in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) result in an odd number of cysteine residues within the epidermal growth factor (EGF)-like repeats in Notch3. We report here R75P mutation in two Japanese CADASIL families not directly involving cysteine residues located within the first EGF-like repeats. Probands in both families had repeated episodes of stroke, depression, dementia as well as T2 high-intensity lesions in the basal ganglia and periventricular white matter, but fewer white matter lesions in the temporal pole on MRI. These families provide new insights into the diagnosis and pathomechanisms of CADASIL.
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  • Isha Shrestha, Tomohiko Ohshita, Hiromitsu Naka, Hiroyuki Morino, Masa ...
    2008 Volume 47 Issue 23 Pages 2073-2076
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    We report a case of a 52-year-old woman with Behcet's disease who presented with dysarthria and right-sided hemiparesis. T2-weighted and diffusion-weighted images (DWI) showed a hyperintense lesion in the left pons with a relatively decreased apparent diffusion coefficient (ADC). Imaging showed almost complete resolution of the lesion after treatment with prednisolone. The atypical DWI and ADC findings in this case may reflect cytotoxic edema due to excitotoxic brain injury. This case thus illustrates the radiological diversity of neuro-Behcet's lesions.
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  • Kenichiro Tamaki, Takashi Nakazawa, Akira Mamehara, Goh Tsuji, Katsuya ...
    2008 Volume 47 Issue 23 Pages 2077-2081
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    We report the case of a 61-year-old man with pyoderma gangrenosum (PG) who was successfully treated with high-dose intravenous immunoglobulin (IVIg). He was transported to hospital with fever, pain and ulcer of the left inner thigh, and pancytopenia. PG associated with myelodysplastic syndrome was diagnosed, and treatment with methyl-prednisolone at 1.0 g/day for 3 days was followed by oral prednisolone. As the ulcer deteriorated when prednisolone dose was reduced, he was admitted to our hospital. IVIg was administered twice, with high fever promptly subsiding and the ulcer markedly decreasing in size. IVIg may represent a good option when steroid therapy proves insufficient.
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  • Taio Naniwa, Tomoyo Maeda, Tsutomu Mizoshita, Yoshihito Hayami, Maiko ...
    2008 Volume 47 Issue 23 Pages 2083-2085
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Upper gastrointestinal tract mucosal irritations, such as esophagitis, have been reported as rare adverse events due to a variety of aminobisphosphonates, including alendronate sodium, which have been widely used to treat osteoporosis. Although the pathogenesis of aminobisphosphonate-induced esophageal mucosal irritation has not been clearly understood, direct chemical esophageal irritation with prolonged local mucosal exposure to the drug with gastric contents might be the most plausible mechanism according to the previously reported literature. Here we report a young adult man with severe ulcerative esophagitis due to alendronate who demonstrated a strongly positive result on a drug lymphocyte stimulation test against alendronate. This case report provides the new concept that T-cell mediated delayed hypersensitivity to the drug may be involved in the pathogenesis of alendronate-induced esophagitis.
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  • Hirokazu Taniguchi, Atsuo Miwa, Hitoshi Abo, Hiroshi Demachi, Saburo I ...
    2008 Volume 47 Issue 23 Pages 2087-2089
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    A patient presented with Sjögren's syndrome associated with pulmonary multiple cystic lesions and a pulmonary arteriovenous fistulae. A histological examination of the lungs during the autopsy revealed the stenosis of the bronchiole lumens with hyperplasia of goblet cells, proliferation of smooth muscles in the inner wall of the bronchioli and retention of mucus in the airway lumens. These small airway changes were accompanied with chronic inflammatory changes of the airways in Sjögren's syndrome and led to the formation of cystic lesions via a ball-valve mechanism. Arteriovenous fistulae were situated around the cystic lesions. There may have been a correlation between the formation of the fistulae and cysts, but no mechanism was indicated in the histological findings. This report reveals that chronic inflammatory changes of the airways in Sjögren's syndrome are sufficient to cause the formation of cystic lesions.
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  • Aygul Dogan Celik, Yahya Celik, Zerrin Yulugkural, Kemal Balci, Ufuk U ...
    2008 Volume 47 Issue 23 Pages 2091-2093
    Published: 2008
    Released: December 01, 2008
    JOURNALS OPEN ACCESS
    Brucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.
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